Thread by @chadhayesmd

when i was in residency, i had an idea for a different practice model. one that would allow me to spend more time with patients, and would let me operate outside the bounds of the typical healthcare system, giving my patients the attention they deserved.

i spent two years working on a business model that i thought would work. i examined similar practices from across the country, took the best parts of them, and implemented them into a practice model that i thought would be great.

but things didn’t go as i had planned. the grand opening was less than grand. i think i saw 2 or 3 patients the first month, which was great for studying for boards, but not so great for paying bills or keeping a practice afloat.

one day, my wife at the time and i were sitting in the office together talking. we'd done everything we could. we’d tried everything we could think of. i was broken. and we had a baby on the way that neither of us knew how we would pay for.

we sat there, on the couch in the waiting room, slid back so people couldn’t see us through the locked glass door. i ran through everything i could think of one more time. and then i choked back tears and asked, “is this it? are we done?” she nodded. we cried.

i talked to the landlord. i called all my families, which was awful not because there were so many, but because they had been the ones who had believed in me and my dream. and then i had to tell the kids.

i didn’t want them hearing about it from someone at school, and it would have been tough to explain why we were boxing up all of the supplies and selling the office furniture. one day, after i picked them up from school, i told them to sit down on the couch so we could talk.

i wasn’t sure how i would tell them. how do you tell your kids you failed? that the thing you’ve been working toward for three years just didn’t work out. i didn’t know where to start, so i sat between them on the couch and put my arms around them. and it just came out.

“you remember this summer when you wanted to start a lemonade stand?”

“yeah. isn’t it too cold for a lemonade stand now?” my oldest asked. it was late november.

“well, yes. but remember when i said you have to buy the lemons and the sugar and the cups? and then you have to make a sign, set up the stand in the right spot, and get enough people to buy your lemonade that you get all that money back, before you finally start making money?”

“uh-huh.”

“well, daddy’s office is kind of like a lemonade stand. it costs a lot of money to keep it open, and no matter how hard we have tried, we couldn’t get enough patients for it to make money.”

“so you’re going to close it?”

“yeah,” i said, holding back tears. “we decided to close it.”

“are you still going to be a doctor?” the younger one chimed in.

“yes, i’ll still be a doctor—just in a different place.”

she looked up at me. “will you still fix my boo-boos?”

i couldn’t hold back the tears anymore. “absolutely. i will always fix your boo-boos.”

it got quiet for a minute, and i realized i was squeezing them tighter. not for them. for me. the oldest broke the silence.

“does this mean we’re going to be homeless?”

“no.” i smiled. “we aren’t going to be homeless. we might have to move. but we won’t be homeless.” the conversation got easier from there. it’s easy to improve from “homeless.”